The Spanish Civil War (1936–1939) as a Driver for a Serious Malaria Epidemic

In this study, we analyse the most intense outbreak of autochthonous malaria during the twentieth century in Spain (1940–1944) which, traditionally, has been linked to the consequences of the Spanish Civil War (1936–1939). Epidemiological data from historical archives during the period 1930–1950 have been analysed. The results show that the war did not have an impact on the lethality of the disease, but it did have an impact on its prevalence and spatial distribution. Between 1943 and 1953, the case fatality rate for the period was 0.34%, similar to those countries where malaria is still endemic. A mismatch was detected between the peak of highest malaria mortality (1942) and the peak of total mortality during the Spanish Civil War (1938). This time lag is associated with the return to their origins of troops and civilians once the war was ended. This caused that areas with low or no malaria prevalence received a large number of malaria carriers thus reactivating the disease. In addition, the climatic conditions during this epidemic peak with higher humidity and warmer temperatures could have contributed to the spread of the disease. The conclusions obtained could help a better understanding of the impact that this, and other more recent war episodes, have had on the appearance of new outbreaks of malaria.